Treatment
Early diagnosis and treatment of acute mood episodes
improve prognosis by reducing the risk of relapse and
doubling the rate of response to medications.26 Medication
selection (Table 6 6,7,27-30) depends on the presenting
phase of illness and its severity. Treatment should continue
indefinitely because of the risk of relapse, which
occurs in one-third of patients in the first year after
presentation and in more than 70 percent of patients
within five years.1
Comanagement with a psychiatrist is
often required because of relapse, treatment resistance,
comorbid psychiatric conditions, and the risk of patients
harming themselves or others. Women of childbearing
age should be educated about the teratogenic effects
of most mood stabilizers and the importance of using
reliable contraception while taking these medications.